Healthcare Provider Details

I. General information

NPI: 1073609574
Provider Name (Legal Business Name): INGE B FORD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 SE WILLOUGHBY BLVD
STUART FL
34994-5060
US

IV. Provider business mailing address

3441 SE WILLOUGHBY BLVD
STUART FL
34994-5060
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-4030
  • Fax: 772-221-4041
Mailing address:
  • Phone: 772-221-4030
  • Fax: 772-221-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 13914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: